Provider Demographics
NPI:1841791902
Name:SPANN-RYAN, SHANNON L (LAC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:SPANN-RYAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1246 HASKELL AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-3346
Mailing Address - Country:US
Mailing Address - Phone:785-856-0384
Mailing Address - Fax:
Practice Address - Street 1:1246 HASKELL AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-3346
Practice Address - Country:US
Practice Address - Phone:785-856-0384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2300013171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist